Mealey's Insurance Fraud

  • October 05, 2020

    Magistrate Issues Protective Order For Financial Information Sought By Insurer

    NEW YORK — A federal magistrate judge in New York on Sept. 22 entered a protective order limiting the scope of information sought in subpoenas Allstate Insurance Co. and its affiliates served on third-party financial institutions and an accountant that did business with a medical clinic accused of making misrepresentations about its ownership, finding that the document requests in the subpoenas were overly broad and need to be "narrowly tailored to seek specific documents related to transactions between the Defendants and others" (Allstate Insurance Co., et al. v. All County LLC, et al., No. 19-7121, E.D. N.Y., 2020 U.S. Dist. LEXIS 176297).

  • September 25, 2020

    Letairis Maker To Pay $97M To Resolve Claims It Used Foundation To Make Copayments

    WASHINGTON, D.C. — The U.S. Department of Justice (DOJ) announced Sept. 23 that Gilead Sciences Inc. has agreed to pay $97 million to resolve allegations that it violated the False Claims Act’s Anti-Kickback Statute (AKS) by setting up a 501(c)(3) foundation that it used to make insurance copayments for Medicare patients who used its pulmonary arterial hypertension drug Letairis.

  • September 24, 2020

    9th Circuit:  Judge Erred In Adopting Restitution Amount For Fire Fraud Scheme

    SAN FRANCISCO — A Ninth Circuit U.S. Court of Appeals panel on Sept. 21 vacated a federal judge in California's ruling ordering a man to pay $243,680.84 in restitution, ruling that the government failed to show that the entire amount resulted from a scheme involving the submission of fraudulent bills to insurers for fires that were set deliberately to obtain policy proceeds (United States v. Brian Stone, No. 18-10382, 9th Cir., 2020 U.S. App. LEXIS 30034).

  • September 17, 2020

    Relator's Allegations Of Kickback Schemes For Blood Tests Survive Dismissal

    SAN FRANCISCO — A federal magistrate judge in California on Aug. 19 held that a relator sufficiently stated claims under the False Claims Act (FCA) and California False Claims Act (CFCA) concerning a laboratory company's alleged operation of schemes that involved the payment of illegal referral fees and the capping of patient deductibles but dismissed without prejudice the relator's causes of action under the California Insurance Frauds Prevention Act (IFPA) because it did not sufficiently allege that it was an interested party (United States, ex rel. STF LLC v. Vibrant America LLC, No. 16-2487, N.D. Calif., 2020 U.S. Dist. LEXIS 150345).

  • September 16, 2020

    Ohio Panel: Fraud Defendant's Counsel Effective During Probation Hearing

    TOLEDO, Ohio — An Ohio appeals panel on Sept. 4 affirmed a trial court judge's decision to order a man who pleaded guilty to insurance fraud to undergo a 180-day substance abuse treatment program and behavioral treatment, finding that court-appointed counsel for the man was effective during his community control hearing (Ohio v. Artis Layson, No. L-19-1204, Ohio App., 6th Dist., Lucas Co., 2020 Ohio App. LEXIS 3222).

  • September 16, 2020

    Durable Medical Equipment Store Owner Sentenced To 21 Months For Inflated Billing

    PORTLAND, Ore. — A federal judge in Oregon on Sept. 10 sentenced a woman to two concurrent 21-month prison terms and ordered her to pay $1.3 million in restitution after she pleaded guilty to counts of health care fraud for submitting inflated bills to private insurers and tax evasion (United States v. Saffron Gustafson, No. 19-cr-369, D. Ore.).

  • September 16, 2020

    State Farm's Suit Over Clinic's Billing Is Timely, Judge Rules

    BALTIMORE — A federal judge in Maryland on Sept. 15 denied a chiropractic clinic's motion to dismiss a lawsuit brought by State Farm Mutual Automobile Insurance Co. and an affiliate over the submission of allegedly fraudulent bills based on the statute of limitations, finding that the insurer sufficiently alleged that it did not discover the scheme until three years before filing suit (State Farm Mutual Automobile Insurance Co. v. Carefree Land Chiropractic, et al., No. 18-1279, D. Md., 2020 U.S. Dist. LEXIS 168131).

  • September 16, 2020

    Fraud Defendant's Request For Release Pending Appeal Denied By Judge

    NEW YORK — A federal judge in New York on Sept. 15 denied a request for reasonable bail or release pending appeal of his conviction and 72-month prison sentence for his role in a slip-and-fall fraudulent insurance scheme, finding that he still poses a threat to the community and that his appeal is merely for the purpose of delay (United States v. Bryan Duncan, No. 18-cr-289, S.D. N.Y., 2020 U.S. Dist. LEXIS 168647).

  • September 16, 2020

    Nurse Practitioner Pleads Guilty To Fraudulently Billing Medicare, Medicaid

    EAST ST. LOUIS, Ill. — A nurse practitioner pleaded guilty in federal court in Illinois on Sept. 8 to one count of felony health care fraud for her alleged submission of 251 claims to Medicare and Medicaid for medically unnecessary visits to nursing homes from May 30, 2017, to June 26, 2007 (United States v. Jami L. Mayhew, No. 20-cr-30132, S.D. Ill.).

  • September 15, 2020

    Health Network's Owner, Managers To Pay $900,000 For Fraudulent Billing

    STATESVILLE, N.C. — A federal judge in North Carolina on Sept. 14 dismissed a False Claims Act (FCA) lawsuit brought against a now-defunct health care network, its owner and two of its managers after they agreed to pay $900,000 to resolve allegations that they submitted fraudulent bills to Medicare and Medicaid for medically unnecessary diagnostic tests and procedures (United States, ex rel. David Majure v. Carolina Comprehensive Health Network PA, No. 15-134, W.D. N.C.).

  • September 14, 2020

    DOJ:  Prosthetics Company To Pay $1.6M To Settle False Claims Act Suit

    WASHINGTON, D.C. — The U.S. Department of Justice announced Sept. 10 that a Louisiana company that provides upper and lower extremity prosthetics to patients entered into an agreement in federal court in Louisiana in which it agreed to pay $1.6 million plus interest to resolve a whistleblower's lawsuit accusing it of violating the False Claims Act (FCA) when billing Medicare for services after its supplier number was deactivated (United States ex rel. Kimberly Throgmorton v. Shreveport Prosthetics Inc., No. 17-881, W.D. La.).

  • September 14, 2020

    6th Circuit Rejects Chris Brown's 'Weak Arguments' For Reversal Of Fraud Verdict

    CINCINNATI — A Sixth Circuit U.S. Court of Appeals panel on Sept. 11 affirmed a jury verdict finding entertainer Chris Brown liable for insurance fraud for submitting a fraudulent claim for coverage of a burglary and fire at a building he owned, rejecting "three weak arguments about the judge's management of the trial and the admission of evidence" (Hanover American Insurance Co. v. Tattooed Millionaire Entertainment LLC, et al., Nos. 19-5483, 19-5550, 19-5551, 19-5562, 6th Cir., 2020 U.S. App. LEXIS 28889).

  • September 14, 2020

    Fraud Defendant's Request For Compassionate Release Due To COVID-19 Denied

    NEW YORK — A federal judge in New York on Sept. 9 denied a request for compassionate release filed by a defendant who pleaded guilty to his involvement in two health care fraud schemes, holding that the 45-year-old's alleged health conditions did not place him at a higher risk of contracting COVID-19 or suffering from severe complications from the virus (United States v. Ilya Kogan, No. 16 CR 221, S.D. N.Y., 2020 U.S. Dist. LEXIS 165653).

  • September 08, 2020

    Judge Rejects Government's Requested $6.8M Restitution Amount In Fraud Suit

    NEW YORK — A federal judge in New York on Sept. 3 denied the federal government's request to order a man who pleaded guilty to counts of health care fraud and conspiracy to commit health care fraud to pay $6.8 million in restitution, finding that the man should be required only to pay $554,331.51 because the clinic where the man worked submitted $6.3 million in bills to insurers for medical services that were provided (United States v. Absaar Haaris, No. 16-cr-756, S.D. N.Y., 2020 U.S. Dist. LEXIS 161315).

  • September 03, 2020

    Homeowner Failed To Prove Insurer Acted In Bad Faith In Denying Fire Loss Claim

    DAYTON, Ohio — An Ohio federal judge on Sept. 1 granted a homeowners insurer's motion for summary judgment on a bad faith claim because no reasonable juror could find that the insurer's denial of coverage for a fire loss claim was unreasonable (Charles A. Waldren v. Allstate Vehicle and Property Insurance Co., et al., No. 18-290, S.D. Ohio, 2020 U.S. Dist. LEXIS 159161).

  • August 26, 2020

    Doctor Gets 30 Years In Prison, Sister Gets 3 Years For Health Care Fraud Scheme

    BIRMINGHAM, Ala. — A federal judge in Alabama on Aug. 24 sentenced a doctor who was found guilty of fraudulently billing Medicare and private insurers for $7.8 million of medically unnecessary immunotherapy and opioid prescriptions to a total of 30 years in prison and sentenced the defendant's sister, a registered nurse who was also involved in the scheme, to three years in prison (United States v. Patrick Emeka Ifediba, et al., No. 19-cr-0103-RDP-JEO, N.D. Ala.).

  • August 20, 2020

    Dentist Sentenced To 1 Year, 1 Day In Prison For Medicaid Fraud Scheme

    EAST ST. LOUIS, Ill.  — A dentist was sentenced to one year and one day in prison and ordered to pay $671,845.20 in restitution by a federal judge in Illinois on Aug. 12 after the provider pleaded guilty in February to three counts of health care fraud (United States v. Yun Sup Kim, No. 19-cr-30111, S.D. Ill.).

  • August 20, 2020

    Divided Ohio Panel Vacates Judge's Resentencing Of Fraud Defendant

    DAYTON, Ohio — A 2-1 Ohio appellate panel vacated and remanded a trial court judge's de novo resentencing of a woman that required her to serve sentences for one count of insurance fraud and one count of engaging in a pattern of corrupt activity consecutively, finding that there were no new facts in the case that warranted the change (State v. Eva Christian, No. 27236, Ohio App., 2nd Dist., Montgomery Co., 2020 Ohio App. LEXIS 2729).

  • August 20, 2020

    New York Appeals Panel Overrules Man's Challenges To Insurance Fraud Conviction

    ROCHESTER, N.Y. — A New York appellate panel on July 24 overruled a man's arguments that his convictions for insurance fraud and falsifying business records should be vacated because a trial court judge improperly admitted evidence and because the sufficiency of the evidence did not support the jury's decision (People v. Terrell L. Murray, No. 299 KA 14-00921, N.Y. Sup,. App. Div., 4th Dept., 2020 N.Y. App. Div. LEXIS 4351).

  • August 19, 2020

    Insureds Seeking Coverage For Fire Loss Failed To Support Bad Faith, Breach Claims

    CHARLESTON, W.Va. — A West Virginia federal judge on Aug. 18 dismissed insureds' claims for breach of contract and bad faith after determining that the insureds failed to allege sufficient facts in support of their breach of contract claim arising out of the insurer's denial of coverage for a fire loss (Robert Sizemore, et al. v. Allstate Vehicle and Property Insurance Co., No. 19-704, S.D. W.Va., 2020 U.S. Dist. LEXIS 148245).

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